Adverse side effects of methylphenidate among mentally retarded children with ADHD

The adverse side effects of methylphenidate were evaluated in 27 children with attention deficit hyperactivity disorder and IQs of 48 to 74 who participated in a double-blind study of two doses of methylphenidate and placebo. A checklist of 13 side effects, generated from the Physician's Desk Reference, was completed by teachers. Rates of irritability, anxiety, moodiness, and activity level decreased significantly when comparing the placebo with drug conditions. However, medication for six (22%) of the children was discontinued because of the appearance of motor tics (three children) and severe social withdrawal (two children), suggesting that mentally retarded children with attention deficit hyperactivity disorder may be at a greater risk for developing these side effects than the nonretarded population.

Efficacy of methylphenidate among mentally retarded children with attention deficit hyperactivity disorder

Twelve children with IQ scores of 50 to 74 (educable mental retardation) who met rigorous diagnostic criteria for attention deficit hyperactivity disorder participated in a double-blind crossover study of the efficacy of two doses of methylphenidate compared with placebo. Dependent measures included behavioral ratings, classroom work output, laboratory measures of attention and learning, and direct observations of social behavior. Improvement with medication on the Conners Hyperactivity Index was observed in 75% of subjects. Significant increases in work output, on-task behavior, and attentional skills were associated with methylphenidate. However, gains in measures of attention were not associated with improvement in learning, as measured by a paired associate learning task. Additionally, no significant increases in appropriate social interactions during free play were associated with methylphenidate. The results suggest that mentally retarded children with attention deficit hyperactivity disorder respond to methylphenidate at similar rates and in similar domains to that of the nonretarded population.

On the fast track

Future nursing programs will be flexible, meeting the learning needs of diverse student populations. Feldman and Jordet describe an accelerated BSN track for nonnurse college graduates that meets that objective. In 3 years of experience with the program, the authors found these adult learners to form cohesive student cohorts and to produce strong graduates. In spite of the highly compressed 1-year program of studies, the project is deemed a success; a high dropout rate is more than compensated for by the high grade point average and the 100/N-CLEX examination pass by graduates. An extraordinary number of graduates intend to pursue graduate study.

Methylphenidate in children with seizures and attention-deficit disorder

This study assessed the safety and efficacy of methylphenidate in children with seizures and attention-deficit disorder. Ten children, aged 6 years 10 months to 10 years 10 months, without seizures while receiving a single antiepileptic drug, were evaluated in a double-blind medication-placebo crossover study with methylphenidate hydrochloride was administered at 0.3 mg/kg per dose and given at 8 AM and 12 PM on school days only. The use of methylphenidate was associated with statistically significant improvements on the Conners' Teacher Rating Scale and on the Finger Tapping Task and with trends toward improvement on the Matching Familiar Figures Test and Discriminant Reaction Time tests. No child had seizures during the study period nor subsequently for those who continued receiving psychostimulants. There were no significant changes of epileptiform features or back-ground activity on electroencephalograms and no alterations in antiepileptic drug levels. Methylphenidate may be a safe and effective treatment for certain children with seizures and concurrent attention-deficit disorder.

Effects of decreased dietary salt intake on blood pressure in preschool children

Salt-restricted preschool black children, 4 to 5 years of age, were found to have significantly lower diastolic and systolic blood pressures than a matched group on a regular diet. The one exception was the systolic readings for the group of female children; no significant difference between restricted and regular salt diets was found.

Intracranial lesions shown by CT scans in 259 cases of first alcohol-related seizures

We obtained CTs in 259 patients with a first alcohol-related convulsion. Each subject had generalized convulsions, recent abstinence from alcohol abuse, and no obvious etiology for seizures other than alcohol withdrawal. Patients with only focal seizures, major head injury, coma, or a severe toxic-metabolic disorder were excluded. We recorded history and signs of minor head injury, presence of headache, level of consciousness, neurologic signs, routine medical examination findings, and subsequent clinical course. Sixteen patients (6.2%) had intracranial lesions on CT. Eight had subdural hematomas or hygromas, two had vascular malformations, two had neurocysticercosis, and one each showed a Berry aneurysm, possible tumor, skull fracture with subarachnoid hemorrhage, and probable cerebral infarction. In ten cases (3.9%), clinical management was altered because of the CT result. History or signs of minor head trauma, headache, level of consciousness, or focal neurologic signs did not significantly correlate with CT abnormality.

Cytoplasmic enzyme patterns in isolated hamster pulmonary alveolar type II cells

Three cytoplasmic enzyme patterns were studied in pulmonary alveolar type II cells isolated from normal adult hamster lung: lactate dehydrogenase (total and isoenzymes), peroxidase, and beta-N-acetylglucosaminidase. Enzyme patterns of freshly-isolated type II cells were found to be different from those of freshly-isolated pulmonary hamster fibroblasts. After both types of cells had been cultured for seven days, no difference in cytoplasmic enzyme patterns remained. Lactate dehydrogenase isoenzyme patterns for type II cells were different from those obtained from polymorphonuclear leukocytes and alveolar macrophages. These data may be useful in detecting sources of lung injury by assessment of enzyme patterns in bronchoalveolar lavage fluid.

Estimating personal performance: a problem for children with school dysfunction

Children with school dysfunction typically do limited planning and fail to use potentially beneficial mediational strategies on cognitive tasks. This study tested the hypothesis that these children are poor at assessing their own performance capabilities, a deficit which might contribute to this passive learning style. Thirty children, 9-12 years old, attending a multidisciplinary clinic in a pediatric setting for school underachievement, and 30 age, grade, and socioeconomic status (SES)-matched controls were asked to predict their performance in four domains of function before they were given the opportunity to perform the tasks. Clinic subjects overestimated their performance to a greater degree than controls in two domains. This performance resembles the performance of younger children on related tasks and may be amenable to therapeutic or educational intervention.

Association of phorbol ester receptor down modulation with a cryptic receptor state

Sustained exposure of GH4C1 rat pituitary cells to phorbol esters or the hypothalamic tripeptide thyrotropin-releasing hormone decreases the number of phorbol ester binding sites without changing affinity (down modulation; Jaken, S., Tashjian, A. H., Jr., and Blumberg, P. M. Cancer Res., 41: 2175-2181, 1981). In untreated control cultures, the concentration of receptors in lysates was not significantly different from the concentration in intact cells. In contrast, in down-modulated cultures, the concentration of receptors in lysates was greater than the concentration in the corresponding intact cells and instead was equal to the concentration in lysates of control cultures. Therefore, the processes of both homologous (phorbol ester-induced) and heterologous (thyrotropin-releasing hormone-induced) phorbol ester receptor down modulation involves the generation of a cryptic receptor state that is revealed upon cell lysis. Furthermore, comparison of receptor properties in cells and lysates revealed that the affinity of the receptor for phorbol dibutyrate was decreased from a Kd of 11.1 +/- 0.6 nM (S.D.) in intact cells to 40 +/- 10 nM in cell lysates. Binding of the receptor for the structurally related diterpene, mezerein, fit a one-component model in intact cells, but was better fit to a two-component model in cell lysates. That is, the apparently homogeneous phorbol 12,13-dibutyrate receptor population in cell lysates appeared heterologous with respect to mezerein binding. This is not due to a preferential recovery of a subset of receptors in the lysates, because no substantial loss of receptor number was associated with cell lysis. Instead, these results suggest that the affinity and ligand specificity of the phorbol ester receptor may depend on its cellular environment.

Neuroepithelial bodies (NEB) and solitary endocrine cells in the hamster lung

Periodic acid-Schiff (PAS)-positive small-granule endocrine cells identified in serial plastic sections through 95% of the infracardiac lobe of a Syrian golden hamster lung were marked on a 70X cardboard reconstruction of the airways and recorded for computerized analysis as described in the preceding paper in this volume [1]. When airways were subdivided into thirds and the resulting small pieces of airway surface were analyzed statistically, endocrine cell loci appeared to be randomly distributed in the epithelial layer. Nevertheless, loci were absent from only 10 of 209 unit airways, far short of the 28 predicted from a random distribution. Solitary endocrine cells accounted for 37% of 980 loci but only 6% of all endocrine cells; 63% of loci consisted of endocrine cell clusters, broadly defined as "neuroepithelial bodies," of from 2 to 107 cells. Although small groups were preponderant, no significant discontinuity occurred in the size distribution between 1 and 56 cells per locus. Neuroepithelial bodies predominated everywhere, but especially in the lobar bronchus and at bronchioloalveolar portals, where cuboidal bronchiolar epithelium gives way to the attenuated epithelium of the respiratory zone; 45% were related to peribronchial smooth muscle and 18% to pulmonary capillaries. Only 3.3% of solitary cells were related to capillaries, 29% to airway muscle; 68% occurred in muscle-free regions of the airway, associated preferentially with ciliated epithelial cells. We conclude that endocrine cells are distributed in such a way that virtually all airways have at least one locus. This nonrandomness suggests that these cells are in fact important to normal lung function. Furthermore, because solitary endocrine cells and "neuroepithelial" cell clusters have different intrapulmonary distributions, they may well have distinct identities and functions.

Small-granule (neuro)endocrine cells in the infracardiac lobe of a hamster lung. Number, subtypes, and distribution

Small-granule APUD (amine precursor uptake and decarboxylation) endocrine cells were surveyed in 600 3 microns glycol methacrylate-embedded, periodic acid-Schiff (PAS)-lead hematoxylin-stained serial sections comprising 95% of the infracardiac lobe of a hamster lung. Results were confirmed by less systematic study of other hamster lungs. Positions of endocrine cells were marked on cardboard profiles of bronchi and bronchioles for assembly into a 70 X enlarged three-dimensional model from which size and branching of the airway were determined. Records were made for computer analysis of the number and staining patterns of endocrine cells, the nature of contiguous epithelial cells, and the presence of underlying smooth muscle and blood and lymph vessels. APUD cells occurred in 95% of all airways, at a mean density of six solitary cells and 10 cell clusters (neuroepithelial bodies) per millimeter of airway length, measured along the bronchial-bronchiolar long axis. Nineteen percent of endocrine cell loci (29% of all cells) were found at bronchioloalveolar portals in all regions of peripheral lung. Twenty percent of loci (28% of all cells) occurred about the origins of lateral airway branches; these included 4% of loci on carinal points of bifurcation. Two groups of APUD cells had distinctive anatomic relationships: 1) 13% of loci (20% of cells) were related to pulmonary capillaries and venules, mainly at bronchioloalveolar portals; and 2) 39% of loci (53% of cells) overlaid peribronchial muscle, mainly in larger airways where changes in diameter might affect ventilation. In this lobe, APUD cells were not related to goblet or mast cells; 74% of loci abutted Clara and/or ciliated cells, 17% great alveolar cells. Few loci were associated with pulmonary arteries and veins. Five APUD cell types were identified by PAS-lead hematoxylin staining. Types I, II, and V, with granules approximately 0.2 micron in diameter, made up 38%, 45%, and 2% of cells, respectively. Types III and IV, 10% and 5% of cells, respectively, had larger granules. Types I, II, III, and V occurred as solitary cells as well as in neuroepithelial bodies. One-third of the neuroepithelial bodies contained a single cell type; the rest were mixed. Type IV cells, with coarse lead hematoxylin-positive granules, usually were found in large neuroepithelial bodies containing two to four cell types and were never seen occurring alone. We conclude that 1) hamster lungs contain different kinds of APUD cells; 2) those likely have a variety of functions; 3) distinctions merely between solitary and clustered cells may not be significant; 4) the histophysiology of many neuroepithelial bodies probably is more complex than previously suspected; and 5) PAS-lead hematoxylin is superior to argyrophilia and amine fluorescence for light microscopic counting and analysis of pulmonary APUD cells in this species.

Relationship between QRS width and the presence of neoplasm

This study examines the relationship between QRS width and the presence of neoplasia. The QRS width was measured in 236 consecutive ambulatory patients. The patients' body surface area, CBC, SMA 6, and SMA 12 were also recorded. There were 17 out of 34 (50%) patients with neoplasia in the group with QRS less than 0.08 seconds. There were only 19 out of 78 (24%) with neoplasia in the group with QRS greater than or equal to 0.08 seconds (P less than 0.01). We conclude that there is a higher incidence of neoplasia in patients with a QRS less than 0.08 seconds than in patients with a QRS greater than or equal to 0.08 seconds. This difference cannot be explained by age, body surface area, hemoglobin, or any variable in SMA 6 or SMA 12.

Plasma creatinine in the first month of life

The creatinine-kinetics method of analysis was used to study the changes, during the first month of life, in plasma creatinine levels in 34 newborn infants receiving no treatment with drugs. Plasma creatinine values during the first 5 days of life ranged from 188 to 17 mumol/l. After day 5 plasma levels were fairly stable throughout the first month, with a mean value of 35 +/- 2 (range 12-62) mumol/l. Twenty-two infants receiving treatment with gentamicin-ampicillin-cloxacillin were also studied. Seven of them had raised plasma creatinine concentrations after day 5, well beyond the range of concentrations found for infants receiving no drugs. Plasma creatinine, measured by the kinetic method, appears to provide a useful index of renal function in the neonatal period.

Heparin-induced thrombotic thrombocytopenia

Following subcutaneous therapy with heparin, the patient developed signs and symptoms of vascular occlusion in both legs. This was accompanied by thrombocytopenia and platelet aggregation when the patient's platelets were incubated with heparin. The clinical features and implications of this syndrome are discussed.

An appreciation of the new St. Jude valvular prosthesis

Beginning in March, 1978, 88 patients have had cardiac valve replacements with St. Jude prostheses. There were 26 males and 62 females, aged 6 to 80 years (mean 60). Single valve replacement was done in 67. Double valve replacement was done in 21; 12 of them had two St. Jude valves and nine had a different second valve. There were 57 mitral and 43 aortic valves replaced. Thirty-six patients had concomitant aorta-coronary bypass, and six others had additional cardiac procedures. All patients have been followed for a total of 807 patient-months (mean 9 months). Seventy-nine have been receiving sodium warfarin and seven are not receiving anticoagulants. There has been one embolic episode. There are no valve failures to date. Early mortality is 2.3% and late mortality, 5.7%; no death was valve related. Fifty-three survivors have improved by two or more N.Y.H.A. classifications. Fifty-four valves studied postoperatively at rest, during pacing, and during isoproterenol infusion have demonstrated significantly better hemodynamic performance than have mitral porcine xenografts studied in an identical manner (p < 0.05). Phonocardiography, M-mode and two-dimensional echocardiography, and cinefluoroscopy, carried out in 18 patients, have proved to be reliable noninvasive techniques for long-term follow-up. This experience indicates that the St. Jude prosthesis offers an excellent and predictable alternative in the surgeon's decision-making concerning valve choices.

Assessment of glomerular filtration rate in children

Five different methods of assessment of glomerular filtration rate (GFR) were compared in 500 children older than one year of age. Results of each method were compared with standard inulin clearance values: 1. An evaluation of glomerular function may be inferred from plasma creatinine levels; the validity of this inference is, however, limited because of the wide range of normal values; 2. creatinine clearance values calculated over 3 hours significantly overestimate inulin clearance values; 3. clearance values derived from plasma creatinine concentration ahd height show a poor correlation with traditionally calculated inulin clearances; 4. clearance values calculated as the sum of twice the creatinine clearance and once the urea clearance, divided by three, better predict inulin clearance than either C-creatinine or C-urea alone; 5 inulin clearance values calculated by dividing the quantity of inulin perfused by its plasma concentration, once it has become stable, differ significantly from the values obtained by the standard inulin clearance.--Of all the methods studied, none was found to be an ideal alternative to the traditional inulin clearance when a precise assessment of GFR is warranted. It is concluded that in most clinical conditions derived clearance values do not have significant advantages over the simple determination of plasma creatinine, a valuable but not infallible index of glomerular function.

Social anxiety and psychiatric diagnosis

Difficulties in interpersonal relationships are common complaints of psychiatric patients, and some investigators have contended that a lack of social skills, excessive social anxiety, and interpersonal problems are important causes of psychiatric disorders. To investigate further the relationship between social anxiety and psychiatric disorders, a survey of outpatients (N = 303) and untreated controls (N = 216) was conducted using measures of social anxiety, self-consciousness, general anxiety, and depression. Schizophrenics, secondary depressives, and nonpsychotic patients in individual and group psychotherapy characterized themselves as most shy in the diagnostically mixed patient group. Patients with primary effective disorders and family therapy patients were less socially anxious and resembled the control group in this respect. The single best predictor of status as a patient vs. status as a control was level of depression as determined by a stepwise discriminant function analysis. The relationship between social anxiety and secondary depression deserves additional attention in order to assess the possible causal links between this variables.

Acoustic and perceptual comparison of chronic and incipient spastic dysphonia

Vocal symptoms of patients with chronic and incipient spastic dysphonia were compared on a number of acoustic and perceptual parameters. Patients with incipient spastic dysphonia displayed less severe strain-strangle phonation, effort, rhythm, and stress. Harshness was the only perceptual parameter on which incipient spastic dysphonics were rated higher than chronic spastic dysphonics. Changes in the acoustic measures of laryngealization, harmonic change, mean vowel duration, and duration ratio between stressed and unstressed vowels accompanied changes in listeners' perception of strain-strangle phonation and effort. The variation in acoustic characteristics such as laryngealization and harmonic change as well as normal phonation indicated that both groups were characterized by a variety of phonatory modes.

Loxapine in neurotic anxiety: some modifiers of treatment response

The authors describe a double-blind trial of six weeks duration which was designed to compare the anxiolytic properties of chlordiazepoxide, loxapine and placebo in a total of 135 anxious neurotic out-patients.

A comparison of transcriptional linkage of tRNA cistrons in yeast and E. coli by the ultraviolet light technique

The ultraviolet light mapping technique was employed to determine the lengths of tRNA cistrons in yeast. The applicability of the method was first tested in the E. coli system, in which the mapping positions for some tRNA cistrons and the ribosomal 5S RNA genes as well as the existence of multimeric transcription units for tRNAs are known. Rates of the synthesis of the tRNAs and small rRNAs after irradiation with various doses of UV light were determined by pulse labeling and quantitation of the RNA species after twodimensional gel electrophoreses. The small ribosomal RNAs served for internal calibration in the estimtion of the target sizes. Our results suggest that--in contrast to the prokaryotic system--in yeast the majority of the tRNA genes are not linked into transcriptional units.

The development of language-like communication without a language model

Deaf children who are unable to acquire oral language naturally and who are not exposed to a standard manual language can spontaneously develop a structured sign system that has many of the properties of natural spoken language. This communication system appears to be largely the invention of the child himself rather than of the caretakers.

Arangement of transfer-RNA -genes in yeast

The redundancy and the arrangement of the genes for specific transfer ribonucleic acids in yeast were studied by the hybridization techniques developed by Birnstiel et al., e.g.[1]. The redundancy was found to be in the order of 10 genes for tRNA1Met, tRNA3Met, tRNA2Ser, and tRNA-Pro. High molecular weight yeast DNA was fractionated by density gradient centrifugation in cesium chloride and the [32p]tRNAs were hybridized to the single fractions. The results together with earlier findings [2] suggest that the cistrons for these tRNAs are arranged in tandem interspersed by 6 to 10 times longer segments of spacer DNA which varies in (G+C) content for the different tRNA species.

Hysterical polydipsia (compulsive water drinking) in children

Two patients had entirely different clinical presentations of hysterical polydipsia: convulsions and coma in a 5-year-old boy with intrinsic renal disease and a single kidney, and abnormal behavior in a 3-year-old girl with normal kidneys. In neither case was the correct diagnosis made on initial evaluation. Physiological studies demonstrated primary polydipsia to be responsible for both clinical presentations. The differential diagnosis of polydipsia and polyuria is reviewed, and the nonuniform presentation of hysterical polydipsia is emphasized. In children with intrinsic renal disease, hysterical polydipsia may be life-threatening.

A trial of deglycyrrhizinated liquorice in the treatment of duodenal ulcer

A double-blind trial of deglycyrrhizinated liquorice was performed in 47 patients with active duodenal ulcer. Twenty-four patients received a placebo and 23 the trial medication (Caved-S) for one month. Both groups were clinically similar. No advantage of deglycyrrhizinated liquorice over placebo was found.

Sex chromatin, body-masculinity and smoking behavior

An hypothesized relationship between smoking behavior, body masculinity ( Masc), and amount of sex chromatin was investigated using 6 samples of California college students ( n = 437) and 1 of 80 Indiana adults. Ratings of Masc were positively correlated with the amount smoked by smokers of both sexes in all samples. Amount of chromatin in both buccal smears and blood neutrophils was higher for smokers in all samples tested. The amount smoked was negatively correlated for male and positively correlated for female smokers with amount of chromatin. Amount of chromatin is related to Masc in females but not in males.

A clinical description of death in rats and the effect of various conditions on the time untile cessation of ventricular contraction following section between the brain and spinal cord

Clinical death has been examined in rats. The time between severing the brain and spinal cord, and the disappearance of the ventricular complex on the electrocardiogram, has been measured. It is much longer in 1 week-old rats than in rats aged 4-56 weeks; it is also prolonged in bilateral pneumothorax and by artificial respiration (particularly if it is started before the animal stops breathing). It is also lengthened by intraperitoneal pentobarbitone, and by keeping the rats in an ambient temperature of 36°. The relevance of these findings to resuscitation of patients is discussed.

Renal transplantation at the University of Pennsylvania Medical Center: an update of results in the cyclosporine era

This chapter presents a summary of living-related, living-unrelated, and cadaver renal transplantation performed at the University of Pennsylvania Medical Center between January 1984 and October 1992. Over the past 9 years, 895 patients (557 males, 338 females, mean age 42 yrs) received 942 renal transplants; 599 patients received kidneys from cadaver donors (n = 627) and 296 patients received kidneys (n = 315) from living donors of all types. During this period, 151 patients were retransplanted, sometimes more than once (159 total retransplants, 124 secondary grafts, and 35 third or more transplants). An analysis of patient ant graft survival rates (calculated by actuarial methods) for different categories of transplant recipients was performed. Black recipients, as a racial subcategory, had the poorest graft outcome, especially when followed over the long term. Graft survival rates for Black recipients who were retransplanted with cadaver grafts were even worse and were noted to be similar to the diabetic population that received cadaver retransplants (66% vs 62% at 1 yr and 32% vs 25% at 5 yrs). Diabetic recipients of living-donor transplants had excellent graft survival results, similar to nondiabetic, living-donor recipients (patient survival rates 98% and 92% vs 97% and 92% at 1 and 5 yrs; graft survival rates 92% and 82% vs 92% and 82% at 1 and 5 yrs). HLA-identical recipients of first cadaver grafts demonstrated the best outcome in the entire cadaver series (graft survival rates 91% and 83% at 1 and 5 yrs, respectively). HLA-identical recipients of second or more cadaver grafts had poorer results than expected (50% graft survival at 1 yr) despite a 100% patient survival rate. HLA-identical recipients of living-related grafts had the best graft survival rates (96% at 1 yr and 94% at 5 yrs) and superior graft survival rates for retransplanted grafts as well (100% at 1 and 5 yrs). We conclude that in the last decade, patient and graft survival rates for cadaveric and living-donor renal transplants have improved dramatically relative to the results obtained in the pre-CsA era. Long-term graft survival in Black recipients remains lower than in other races, suggesting the need to analyze other factors to explain poorer graft survival in this recipient population. Results in diabetic recipients continue to be excellent at our center, encouraging the continuation of our aggressive approach to try to transplant diabetics as early as possible, particularly when a living donor is available.